Hello. My name is Nikki and my pronouns are she/her/hers.
Have you ever had someone call you by the wrong name or make an assumption about your identity that was untrue? If you have, you know how uncomfortable that can feel. Sometimes, it’s fairly easy to correct the other person and other times it’s not. There are a lot of factors that play into how comfortable and affirming, or uncomfortable and potentially even unsafe, the spaces we create are.
Now imagine that someone else misjudges a huge, core aspect of who you are, like your gender identity. For many of us, our gender identity corresponds to the sex we were assigned at birth. The term for this is cisgender. But for many others, this is not the case. For transgender and gender nonbinary people, the sex they were assigned at birth does not reflect who they are, and it can be incredibly painful and stigmatizing when they are misgendered.
Pronouns are the most obvious way we denote someone’s gender identity. If you are cisgender, you may think this seems very straightforward. However, the assumption that you can determine someone’s gender identity, and thus pronouns, by looking at them or by seeing their name in print might make sense at first, but it is actually impossible to do. The reality is, the only way we really know someone’s pronouns, or their gender identity, is if we ask them or they tell us.
This number is a lot higher than most people think, and it also doesn’t reflect transgender youth who do use he/him or she/her. For example, many trans girls (people who were assigned male sex at birth but whose gender identity is female) use she/her, and many trans boys (people who were assigned female sex at birth but whose gender identity is male) use he/him.
The most obvious reason this matters is because all of us deserve to be treated with dignity and respect, and to have others honor our identities. If you have ever had someone invalidate your identity, even if they didn’t mean to, you may remember how painful that felt. For trans youth, it can even be the difference between life and death.
Suicide is the second leading cause of death of U.S. adolescents, and LGBTQ+ youth are at much higher risk than their cisgender, heterosexual peers. In fact, according to the Trevor Project, 50% of LGBTQ youth aged 13-17 considered suicide in the past year, and 18% attempted. Among transgender youth, their risk of suicide is double that of their cisgender LGB peers, and four times that of their cisgender, heterosexual peers. It is important to note that as disturbing as these trends are, they are also not equally felt across different racial and ethnic groups; Indigenous, Middle Eastern/North African, Black and Hispanic youth attempt suicide at much higher rates than their white peers.
We all know that there is a youth mental health crisis in this country, and we know that among our LGBTQ+ youth, particularly those of color, the situation is even more dire. So what can we do?
We can create affirming spaces for our LGBTQ+ youth. The most straightforward way to do this is to honor their identities and their pronouns. A lot of people worry about “getting it wrong,” but we all make mistakes. What matters far more is that we ask, we listen, we try, and if we make a mistake, we acknowledge it, apologize and try harder the next time.
It’s also critically important to note that we should normalize pronoun use for everyone. Like I said, the only way you can know someone’s pronouns is if you ask or they tell you. So that means pronouns aren’t just for transgender and nonbinary youth, they’re for everyone. It can feel odd at first but if you get in the habit of introducing yourself with your name and pronouns, like I did here, it starts to feel normal very quickly. This includes in virtual meetings, emails, letters, and other forms of communication. You can save an email signature or a screen name so you don’t have to remember every time.
"A lot of people worry about 'getting it wrong,' but we all make mistakes. What matters far more is that we ask, we listen, we try, and if we make a mistake, we acknowledge it, apologize and try harder the next time."
- Dr. Nicole Webb
Creating affirming spaces isn’t just the right thing to do, it keeps transgender and nonbinary kids safer. In fact, one study found that for transgender and nonbinary youth, use of chosen name and pronouns resulted in a 29% reduction in suicidal ideation and a 54% reduction in suicidal behavior. This is true where kids live, learn and play, so schools, community organizations and faith groups all play a role. However, the single most important environment in which an affirming space is protective against transgender suicide risk is the home. Yet fewer than 1 in 3 transgender youth report living in a home environment that is affirming of their gender identity.
Underlying all of this is one core truth: being transgender or nonbinary is not a choice, but our use, or not, of the pronouns our kids tell us reflect who they are is a choice. And it’s one that could save our kids’ lives.
About the Author
Dr. Nicole Webb joined Valley Children's in August 2012 as a pediatric hospitalist. Board certified in both general pediatrics and pediatric hospital medicine, Dr. Webb is passionate about patient and family-centered care, medical education, health equity, and advocacy. In her various leadership roles, she seeks to advance the voices of patients and families, particularly those often unheard, in all that we do. She has led organizational efforts in diversity, equity, and inclusion, particularly pertaining to creating affirming spaces for LGBTQ+ youth. She is dedicated to resident and medical student education, and to helping the next generation of physicians become not only excellent clinicians, but also strong advocates for our kids, both within and even more importantly, outside the walls of the hospital.